by Barbara Ebel
“I don’t know how you do it. Find this shit out when the territory is right in my own back yard. Excuse my French.”
Cathy shrugged.
“I personally like her.”
“Hmm. Is that so?” She finally smiled. “So, getting back to Jessy Winter. You will be the bearer of bad news. By tomorrow, Friday, please tell him that his hospital privileges are being revoked by midnight.”
Jeffrey gulped, without drinking any coffee.
CHAPTER 12
“Did you go to the ICU and appease that patient?” Dr. Nettle asked.
“There’s no appeasing him,” Viktoria said, waiting for him to write her name on the scheduling board, “but at least he’s on his way out of the unit.”
“He’s a lucky man, then. People with triple A’s have no idea that before their repair, they’re walking time bombs.”
“So true. Too bad the sufentanil I gave him had no effect. Can you imagine? 100 mcgs of the stuff?!”
Phillip’s eyes grew larger. “Perhaps the vial came from China.”
“Hmm. You bring up a plausible line of thinking. Although unlikely, bad drugs are a possibility.”
“We don’t routinely use sufentanil around here, you know.”
“I understand that. I don’t either. However, it is part of our pharmaceutical armamentarium and I dig into our box of tricks and use the best resources for the most appropriate situation.”
“Now that you have that off your chest, I’m assigning you two rooms to supervise CRNAs. An anal fistula with Susan Rust and an exploratory lap with Tim Stuart. He used cursive on the white board, but stalled with the spelling of her name.
“d – o – t – t – i – r,” she completed after he wrote “Thors.”
He whipped his glasses off his nose, took another look to satisfy himself, and pointed to the preop area. “Your patients are waiting on you.”
In the preop room, Viktoria pulled the curtain aside for the fistula patient. “Mr. Guthrie, I’m Dr. Thorsdottir, the anesthesiologist. Here to evaluate you.”
The man glued his eyes on her and didn’t let go. “I’m sorry. I already told everyone here that I only want people over sixteen years old taking care of me.”
Viktoria’s mouth froze in place. He had to be kidding. She unlocked her jaw. “I qualify, Mr. Guthrie. I am a whopping thirty-nine years old.”
His eyebrows twitched. “You are yanking my chain. You look so young. Goes to show. I’m an ancient seventy-nine-year old, so everyone under forty looks like they’re wearing a baby’s face.”
She let her amusement register on her face. “You just convinced me not to buy all those facial skin products. A baby’s face is smooth as butter and doesn’t need a thing.”
“At least I did something right today before I go butt up in an operating room for all to see and make fun of.”
“No one will make fun of you. That’s a promise.”
“I hope so, young woman. Otherwise, I’ll turn over in my grave next year.”
Viktoria shook her head at him and took his history. Lastly, she started his IV.
“Be aware,” he said as she left, “only a thirty-nine-year old had permission from me to put in my IV.”
She gave him a thumbs up, grateful for his humor after a bad start to the day.
-----
With a concerted joint effort, the OR staff, Susan, and Viktoria flipped Mr. Guthrie prone making him “butt up,” the position he dreaded. Making sure the endotracheal tube had not dislodged, Dr. Thorsdottir checked from below the table, especially making sure the tape was secure on the tube and his eyes. She re-listened to breath sounds over his back, making doubly sure that both lungs were equally ventilated.
Mrs. Rust made sure his IV was not kinked and padded his arms. When they finished his positioning, Viktoria recorded vital signs and Susan tweaked the anesthesia.
Susan huffed and puffed. “I’m getting too old for this.”
“Are you okay? Turning a patient prone entails more physical exertion. Maybe it’s too much for you.”
“I’ll be fine.”
“In the eyes of our patient, your age is downgraded. He suggested significant aging doesn’t begin until you turn forty.”
“Hell, then I’m a good twenty years into it.” She pushed the stray, graying hair over her ears into the OR bonnet.
“And I’m galloping up behind you. Be aware this morning that between my other duties, I will be happy to give you a break when I can.”
“Appreciate that.”
“I didn’t notice Jennie Shaw or Casey Johnston’s name on the board so far this morning. Are they the floaters today? Or are they absent from the caseload or working a late shift?”
“Oh, gosh, no. Their big day is on Saturday. They’re taking off today and tomorrow. Although they hired help at home, they still have too many details to attend to, especially since the wedding and reception is at their house. No telling how elaborate their ceremony and party is going to be. I only hear rumors. If it means anything, even her dress was special ordered from New York City.”
“I suppose you only get married once,” Viktoria said, turning the dial on the vaporizer. “Hopefully, that is.”
“You married?”
Viktoria nodded. “Are you?”
“Sure thing. He’s still working too. Part-owner of a gift and card store. The business makes a little money, especially since there’s a shortage of them in Masonville. Does a bit better during the summer from tourists spilling over from the lake.”
“A blissful married and productive life if you ask me.”
“Suppose so.”
The nurse’s prep was finished, and she hoped the forthcoming fistulotomy would be successful. As she walked around the table, the surgeon and Viktoria nodded at each other. The anal fistula looked painful, a nasty inflammatory tract running between the perianal skin and the anal canal. Mr. Guthrie would be one relieved patient to wake up after his procedure.
-----
Jessy Winter rode over to his OB/GYN practice where he strutted to the back door. The entrance faced other complexes and a dumpster and kept the docs from fielding questions from patients in the front parking lot. Besides, Jessy loved anonymity outside of his profession. He was a loner, always had been, and the most he ever interacted with people was in his profession.
He had delivered a throng of babies over the years: healthy ones, sick ones, premature ones, late ones, ones with genetic defects hanging on for dear life, and sadly enough, dead ones. Over the course of his life, delivering well babies was the best thing he ever did which brought him joy. Bringing newborns into the world counted as a blessing. It was only too bad the specialty came with the high cost of malpractice insurance and the occasional poor result that a patient sued over. But he would still go into OB if he had to do it all over again.
GYN, on the other hand, was less rewarding, but nonetheless important. He better start enjoying it more, he thought, as he yanked open the door. Sooner or later, like a lot of docs, he would be forced out of the high cost of doing obstetrics, and fall back on only practicing gynecology. It may be sooner than he liked, too, if his final divorce findings go as bad as his attorney was thinking. Scaling down on the cost of doing obstetrics may end up being a necessity, so he can budget his income and expenses in a more favorable light.
He shared the practice with three other doctors, the newest one being a female. Patients loved her, and most new patients were trying to make it on her schedule. It was the going rage, women patients seeking out physicians of the same sex when it came to their private parts. He could understand it. No way would he go to a female urologist for prostate problems.
In the office, he peeked at the two women at the front desk. One of them came forward with his list of patients to be seen for the day. The chatter from the waiting room filtered his way, and he surmised that he and one of his partners were going to be hustling along all day. But he looked at the list anyway.
Firs
t patient was ready and waiting.
“Dr. Winter,” his nurse said and then cleared her throat. “I’ll get a clean white coat for you. Please don’t think I’m being rude, but you may want to tuck in your shirt.”
“Yes, Mary. Whatever you say. Point well taken.”
She had watched the man deteriorate both mentally and physically in the past few months, and she worried about him, despite the fact that he was her least favorite doc in the practice. “Did you grab something to eat before coming in?”
“Sure. I stocked up over in the doctor’s lounge.”
She frowned, well aware that the rumors of him bunking over in the hospital were true regardless of whether he was on call. “I’ll bring your lab coat into your office and grab you a cup of coffee. There’s a phone message on your desk. Your lawyer couldn’t reach you on your cell phone. Your first patient, Mrs. Brenner, can wait a few minutes.”
“I’ll pick up my own coffee on the way. Have to wash down what he says to me with something.”
Jessy took the robust blend back to his office. All his degrees and significant framed medical accomplishments were hung on the wall or stacked against the wall. The ones on the floor were new to the office after he managed to snatch them from the marital house. One of these days, he thought, he should put hammer to nail and squeeze them into some open wall space.
He noted the paper on his desk stating his attorney, Toby Fisher, called a half hour ago. His sip of coffee went down smooth, and he tried to use it as a solacing gesture because the proceeding conversation may just be the end result of legal maneuvering for some time.
It would be much better to not call his lawyer on the office line in case someone accidentally picked up. After touching his cell phone screen, it came alive, and he speed dialed.
“Dr. Winter, you’re officially divorced, so at least that’s over with. I will email you the documents, the final findings of the court.”
Jessy rolled the saliva around in his mouth. Except for the official date, getting divorced was no big news. His wife had initiated the proceedings and had been a bull to expedite things through her attorney. What he really wanted to hear were the details and, no doubt, his lawyer was too much of a coward to tell him over the phone.
“Patients are stacked up, so why don’t you give me the highlights?”
“Dr. Winter, you’re out of the house, so it won’t come as a surprise that your wife keeps the house.”
Jessy cringed. “That was not what I wanted and you know it. I left because she was going to cry mental anguish, physical abuse, or something or the other if I stayed, and we lived under the same roof. Besides, I bought that house lock, stock, and barrel.”
Toby Fisher let what he said go right over his head. Empathy was not part of his job. If he had any, it would only serve to slow down his clients’ cases. “I hear you, Jessy. The judge had the final say. You and I did our best to present your case.”
“I’m already strapped financially. It’s going to be difficult to get a half-way decent place. I just can’t swing it right now, especially after paying all these GD legal bills. Maybe I can find some low-cost rental unit because my daughter is going to need a place to stay.”
Now it was Toby Fischer’s turn to cringe. He kept it short and launched ahead. “She’ll be staying with her mom. You can see her every other weekend and one night a week, but no stay-overs because of your living situation.”
Jessy thought he’d stroke. The highlight of his whole life was his daughter. The anger welled up in him so suddenly that he felt like throwing the phone across the room. Punching a wall would be better.
Toby expected the doctor to tear into him. He plunged forward with more awful findings, so he would not get bombarded by his client’s rage in installments. Now came the alimony part.
“Your wife mostly ran around doing part-time, low-paying social work and dabbling in philanthropic causes. Besides child support for your daughter, the judge ordered you to pay her alimony for a long time.”
Dr. Winter’s heart pounded so hard, now he thought a heart attack would follow a stroke. “That’s insane. What about me?”
He squeezed his eyes tight as Mary walked in. He opened them to find her standing in front of his desk, so he spun around to face the back wall.
“This is deplorable! I guess if we want to take a stab at changing it, I would need to appeal.”
“That’s correct.”
“More money down the drain. For what? Other liberal judges will just uphold what the lower court ruled while I stay a homeless victim of the whole process.”
Dr. Winter was correct of course, Toby realized, but no sense in siding with him not to appeal. An appeal would put more money in his pocket, but he left Jessy’s comments alone.
“I gotta go. My nurse is here and patients are waiting on me. Thanks for trying to work this out to my benefit. The writing was on the wall. I have M.D. behind my name and my wife’s been living a tidy, expensive existence which is now going to be even better. So, in the end, thanks for nothing, Rick. I have mostly myself to blame.”
“Like you said, Dr. Winter. You better get going. You have patients to see.”
Dr. Winter pressed off the call. Sure, he thought, I better hustle through my office hours. Anybody having something to do with my divorce has their open hand stretched out.
Mary uncomfortably stepped from one foot to the other. She should have left right away when Dr. Winter was divulging personal divorce findings, but it was too late. Her poor boss. In her estimation, she gathered that his bad times were not yet over.
-----
“Much better,” Viktoria said. She stood to the side of Mr. Guthrie’s OR table glancing at the surgeon’s repair of his fistula. “He’s going to be happy with you, once he can sit down properly again.”
“Hopefully my ears won’t be ringing and pain medication will help him out.”
Viktoria nodded and went up to Susan Rust. “I only now found time to give you a break. Go get yourself a nice hot coffee and a donut.”
“But Dr. Thorsdottir, we’re almost finished.”
“That’s okay, Susan. Take your full break. We’ll turn him back supine while you’re away, which will make it easier on you.”
The woman cocked her head, wondering if that was Viktoria’s intent to start with. “Whatever you say.”
“How many narcotics has he had?”
“Two ccs of fentanyl.”
“Sounds fine. And his vitals seem to like it.”
Susan straightened the syringes on top of the cart for a moment then walked around the cart and was out the door.
Viktoria began preparing for the end of the case as the surgeon dressed Mr. Guthrie’s hind end. With the surgical part over, someone stood at the top and bottom and both sides of the table, so they could turn the patient supine. Soon she had his eyes untaped, his endotracheal tube out, and all the monitors unhooked. Viktoria waved off Susan when she came back in, and said, “You can take over again by giving report in the recovery room.”
Susan liked that idea and headed over ahead of the stretcher. En route, she passed Dr. Nettle and Dr. Huff. “Were you happy with your attending?” Dr. Huff asked.
“As much as can be.”
“Patient do okay?” Phillip asked.
“Jeez. I’m only a senior citizen with busloads of experience and despite the cold shoulder Dr. Thorsdottir gets around here, I’d have her do my anesthesia in a jiffy.”
The two MDs looked at each other. Susan realized she wasn’t needed anymore and continued on her way.
“Let’s ask her,” Jay Huff said. “If she goes for it, I’ll be ecstatic.”
CHAPTER 13
Mr. Guthrie’s eyelids slid open in the recovery room, and he succeeded in giving half smiles to the surrounding faces. “I’m alive,” he said. “I will live to sit again.”
“Congratulations,” Dr. Thorsdottir said. “Your surgery is behind you.”
“Ha, ha,” he chu
ckled. “That was funnier than mine.”
“I aim to please and you did absolutely fine.” Viktoria glanced again at his vital signs while Susan gave the nurse a report. She spun around and hustled through the automatic door to come face-to-face with Jay Huff and Phillip Nettle.
“Dr. Thorsdottir,” Jay said, “Do you have a minute? How about we find out what the chef put out for lunch today?”
“Sure thing. I planned on something over there whenever I can.”
They sauntered over and Jay opened the door. Inside, Viktoria started to recognize a few faces. Most of the chatter was work related; especially docs talking about their morning consults to one another.
Jay snatched an empty table and placed his coat on a chair. Viktoria ladled a small bowl of chili and a half sandwich and went to the table.
Dr. Huff brought back drinks for both of them and settled across from her. “Schedule’s not too bad today. We may all be able to leave by the time the night call doc comes in. Not you. You’re out of here at three no matter what.”
“Officially, but like I’ve mentioned, sometimes I have inpatients from the day before whom I prefer to check on myself.”
“Oh yes, I forgot about that. That’s commendable of you.”
They both bit into their sandwiches and Viktoria added a sugar packet to the tea. Jay leaned forward and flinched his narrow shoulders together.
“We were wondering,” he said, “if you wouldn’t mind doing something different tomorrow. Come in at 7 p.m. instead of 7 a.m. and be the anesthesiologist on call? There is a back-up doc on call in case you get in over your head.”
“Get in over my head?”
“Well, you know what I mean.”
“No, I don’t know what you mean, which is why I asked.”
“For instance, what if you couldn’t find something or had trouble with a surgeon?”
“Are you patronizing me? Dealing with surgeons is what anesthesiologists do on a regular basis.”
“I’m sorry. I didn’t mean to suggest you can’t handle yourself.”
Viktoria thought about his actual request and Buddy sprung to mind. Although she would need to take a nap tomorrow to manage making it through the night call, she would be able to spend time doing something fun with him. Dog bonding!